• bile acids
• fecal microbiota transplantation
• gastrointestinal microbiome
• gut dysbiosis
• heart failure
• hydrogen sulfide
• prebiotics
• probiotics
• short-chain fatty acids
• trimethylamine N-oxide

• Humans
• Gastrointestinal Microbiome/physiology
• Heart Failure/metabolism
• Heart Failure/microbiology
• Heart Failure/etiology
• Animals
• Myocardial Ischemia/metabolism
• Myocardial Ischemia/microbiology
• Methylamines/metabolism
• Signal Transduction
• Hydrogen Sulfide/metabolism

• R01 HL174472 NHLBI NIH HHS
• R01HL147586 NIH HHS
• R01HL159865 NIH HHS
• 24CDA1263497 American Heart Association
• R01 HL162124 NHLBI NIH HHS
• R01HL162124 NIH HHS
• R01 HL147586 NHLBI NIH HHS
• R01 HL159865 NHLBI NIH HHS

• gut microbiota
• mendelian randomization
• meta-analysis
• plasma metabolites
• ulcerative colitis

• Humans
• Gastrointestinal Microbiome/physiology
• Colitis, Ulcerative/microbiology
• Colitis, Ulcerative/blood
• Colitis, Ulcerative/genetics
• Mendelian Randomization Analysis
• Genome-Wide Association Study
• Male
• Female
• Middle Aged
• Longitudinal Studies
• Canada

• air pollution
• gastrointestinal microbiome
• lung–gut–liver axis
• microbiome dysbiosis
• respiratory microbiome

• R01 ES031253 NIEHS NIH HHS
• R01ES031253 NIEHS NIH HHS
• R01ES03125304S1 National Institute of Environmental Research

• Lactobacillaceae
• Auraptene
• NF-κB
• intestinal barrier

• Animals
• Dextran Sulfate/toxicity
• Colitis/chemically induced
• Colitis/drug therapy
• Colitis/microbiology
• Mice
• Gastrointestinal Microbiome/drug effects
• Coumarins/pharmacology
• Coumarins/therapeutic use
• Intestinal Mucosa/drug effects
• Intestinal Mucosa/microbiology
• Intestinal Mucosa/metabolism
• Intestinal Mucosa/pathology
• Mice, Inbred C57BL
• NF-kappa B/metabolism
• Anti-Inflammatory Agents/pharmacology
• Anti-Inflammatory Agents/therapeutic use
• Male

• 2022B15 Norman Bethune Program of Jilin University
• YDZJ202301ZYTS103 Science and Technology Development Program of Jilin Province
• YDZJ202201ZYTS002 the Science and Technology Development Program of Jilin Province

• clinical evidence
• mechanism
• shenling baizhu powder
• signal pathway
• ulcerative colitis

• Cereus sinensis
• antibiotic-associated diarrhea
• gut microbiota
• polysaccharide
• short chain fatty acid

• Science and Technology Commission of Shanghai Municipality
• National Natural Science Foundation of China-Henan Joint Fund

The incidence and prevalence of inflammatory bowel disorders (IBD) are increasing around the world due to bacterial infection, abnormal immune response, etc. The conventional medicines for IBD treatment possess serious side effects. Periplaneta americana (P. americana), a traditional Chinese medicine, has been used to treat arthritis, fever, aches, inflammation, and other diseases. This study aimed to evaluate the anti-inflammatory effects of oligosaccharides from P. Americana (OPA) and its possible mechanisms in vivo. OPA were purified and biochemical characterization was analyzed by HPGPC, HPLC, FT-IR, and GC–MS. Acute colitis mice model was established, the acute toxicity and anti-inflammatory activity were tested in vivo. The results showed OPA with molecular mass of 1.0 kDa were composed of 83% glucose, 6% galactose, 11% xylose, and the backbone was (1→4)-Glcp. OPA had potent antioxidant activities in vitro and significantly alleviated the clinical symptoms of colitis, relieved colon damage without toxic side effects in vivo. OPA exhibited anti-inflammatory activity by regulating Th1/Th2, reducing oxidative stress, preserving intestinal barrier integrity, and inhibiting TLR4/MAPK/NF-κB pathway. Moreover, OPA protected gut by increasing microbial diversity and beneficial bacteria, and reducing pathogenic bacteria in feces. OPA might be the candidate of complementary and alternative medicines of IBD with low-cost and high safety.

• Periplaneta americana
• gut microbiota
• immune
• inflammatory bowel disorder
• oligosaccharide
• oxidative stress

• IBD
• Immune dysregulation
• Inflammation
• Microbiome
• Rosacea

• 16S rRNA
• Gut microbiota
• High-throughput sequencing
• Toll-like receptors
• Ulcerative colitis

• China
• Colitis, Ulcerative
• Dysbiosis
• Feces
• Gastrointestinal Microbiome
• Humans
• RNA, Ribosomal, 16S/genetics

(1) Background: Inflammatory bowel diseases are pathologies of unknown etiology and auto-immune pathogenia. The use of probiotics is studied in order to increase the arsenal of treatments. The aim was to assess the efficacy of the probiotics in these diseases in the active or quiescent phases; (2) Methods: A systematic review with meta-analysis was performed by an exhaustive bibliographic search in Medline, Cinahl, Embase, Scopus, Web of Science, and Cochrane Library. The inclusion criteria were studies of more than 10 years, English/Spanish, clinical trials, and involving human beings. Relative risk was used to compare efficacy, which was meta-analyzed using a fixed effects model. Heterogeneity was evaluated with the Higgins I² test; (3) Results: Nineteen studies were included in the systematic review and 17 in the meta-analysis, with a total of 1537 patients (n_{experimental group} = 762; n_{placebo group} = 775). There are significant remission differences in ulcerative colitis (relative risk (RR) = 0.81; 95% CI = 0.72–0.91; I² = 32%; p = 0.16). However, no significant differences were found in the use of probiotics for the prevention of ulcerative colitis, and for the remission of Crohn’s disease; (4) Conclusions: There are data showing an additional beneficial effect of probiotics on active ulcerative colitis. More and better studies are needed which assess its possible therapeutic efficacy for quiescent ulcerative colitis and for Crohn’s disease.

• Crohn’s disease
• efficacy
• inflammatory bowel disease
• probiotics
• ulcerative colitis

• Adult
• Combined Modality Therapy/methods
• Humans
• Inflammatory Bowel Diseases/drug therapy
• Probiotics/pharmacology
• Treatment Outcome

Introduction: Exclusive enteral nutrition (EEN) and corticosteroids (CS) are effective induction therapies for pediatric Crohn’s Disease (CD). CS are also therapy for ulcerative colitis (UC). Host–microbe interactions may be able to explain the effectiveness of these treatments. This is the first prospective study to longitudinally characterize compositional changes in the bacterial community structure of pediatric UC and CD patients receiving EEN or CS induction therapy. Methods: Patients with diagnoses of CD or UC were recruited from McMaster Children’s Hospital (Hamilton, Canada). Fecal samples were collected from participants aged 5–18 years old undergoing 8 weeks of induction therapy with EEN or CS. Fecal samples were submitted for 16S rRNA sequencing. The Shannon diversity index and the relative abundance of specific bacterial taxa were compared using a linear mixed model. Results: The clustering of microbiota was the highest between patients who achieved remission compared to patients still showing active disease (p = 0.029); this effect was independent of the diagnosis or treatment type. All patients showed a significant increase in Shannon diversity over the 8 weeks of treatment. By week 2, a significant difference was seen in Shannon diversity between patients who would go on to achieve remission and those who would not. Conclusion: The gut microbiota of pediatric UC and CD patients was most influenced by patients’ success or failure to achieve remission and was largely independent of the choice of treatment or disease type. Significant differences in Shannon diversity indices occurred as early as week 2 between patients who went on to achieve remission and those who continued to have active disease.

• exclusive enteral nutrition
• induction of remission
• microbiome
• pediatric inflammatory bowel disease

• Dextran sulfate sodium-induced colitis
• Lactococcus lactis
• Probiotics

Imbalance of intestinal microbiota was closely related to colitis. Under these circumstances, regulation of enteric flora may be beneficial to the repair of inflammation. We aimed to investigate the effects of probiotics (Bifidobacterium and Lactobacillus), prebiotics and their combination on inflammation, and microflora in mice of acute colitis.

C57BL/6J mice were divided into six groups randomly (blank control group, model control group, probiotics group, synbiotics group, lactitol group and probiotics + lactitol group). Each group was given 2.5% dextran sulfate sodium drinking water for 5 days other than the blank control group. Except for the model control group, the other four groups were intervened with probiotics, synbiotics (probiotics and inulin), lactitol, and probiotics + lactitol. Mice were sacrificed after 1 week of gavage, and pathologic scores were calculated. The feces of different periods and intestinal mucosa samples were collected to analyze the differences of intestinal microbiota by 16S rRNA sequencing. Differences of two groups or multiple groups were statistically examined through unpaired Student t test and analysis of variance (ANOVA), respectively. ANOVA, Tukey, Anosim, and metastats analysis were used to compare differences of microbiota among different groups.

After gavage for 1 week, the pathologic scores of groups with the intervention were significantly lower than those in the model control group, and the difference was statistically significant (P < 0.05). The model control group was higher in the genus of Bacteroides (relative abundance: 0.3679 vs. 0.0099, P = 0.0016) and lower in Lactobacillus (relative abundance: 0.0020 vs. 0.0122, P = 0.0188), Roseburia (relative abundance: 0.0004 vs. 0.0109, P = 0.0157), compared with the blank control group. However, the same phenomenon was not found in groups gavaged with probiotics and lactitol. Compared with model control group, mice with intervention were increased with Bifidobacterium (relative abundance: 0.0172 vs. 0.0039, P = 0.0139), Lachnospiraceae_NK4A136_group (relative abundance: 0.1139 vs. 0.0320, P = 0.0344), Lachnospiraceae_UCG-006 (relative abundance: 0.0432 vs. 0.0054, P = 0.0454), and decreased with Alistipes (relative abundance: 0.0036 vs. 0.0105, P = 0.0207) in varying degrees. The mucosal flora was more abundant than the fecal flora, and genus of Mucispirillum (relative abundance: 0.0207 vs. 0.0001, P = 0.0034) was more common in the mucosa. Lactitol group showed higher level of Akkermansia than model control group (relative abundance: 0.0138 vs. 0.0055, P = 0.0415), probiotics group (relative abundance: 0.0138 vs. 0.0022, P = 0.0041), and synbiotics group (relative abundance: 0.0138 vs. 0.0011, P = 0.0034), while probiotics + lactitol group had more abundant Akkermansia than synbiotics group (relative abundance: 0.0215 vs. 0.0013, P = 0.0315).

Probiotics and prebiotics reduce the degree of inflammation in acute colitis mice obviously. Mice with acute colitis show reduced beneficial genera and increased harmful genera. Supplementation of probiotics and prebiotics display the advantage of increasing the proportion of helpful bacteria and regulating the balance of intestinal microbiota. Lactitol might promote the proliferation of Akkermansia.

Inflammatory bowel disease (IBD) represents a group of intestinal disorders with uncontrolled and chronic inflammation which include Crohn¡¯s disease (CD) and ulcerative colitis (UC). The incidence of IBD is increasing dramatically in Asian countries, especially in China. Recent studies have observed changes in the amount and structure of the gut butyrate-producing bacteria in IBD patients, which suggested that butyrate-producing bacteria might be related to the occurrence and development of IBD. This review will focus on the anti-inflammatory effects of butyrate-producing bacteria by producing butyric acid and butyrate and inhibiting inflammation as well as the immune characteristics of three species of butyrate-producing bacteria: Roseburia intestinalis, Faecalibacterium prausnitzii, and Clostridium butyricum. These mechanisms provide some new ideas and clues for IBD prevention and treatment.

• Gut bacteria
• Butyrate-producing bacteria
• Inflammatory bowel disease
• Butyric acid

• GPR41/43 respectors
• Gut microbiota
• Hericium erinaceus
• Polysaccharide
• SCFAs
• Ulcerative colitis

• Acetates
• Animals
• Antioxidants/therapeutic use
• Basidiomycota/immunology
• Colitis, Ulcerative/chemically induced
• Colitis, Ulcerative/drug therapy
• Disease Models, Animal
• Fatty Acids, Volatile/metabolism
• Female
• Fungal Polysaccharides/therapeutic use
• Gastrointestinal Microbiome/drug effects
• Gastrointestinal Microbiome/physiology
• Humans
• Inflammatory Bowel Diseases/drug therapy
• Male
• Mycelium
• Rats
• Rats, Sprague-Dawley
• Receptors, G-Protein-Coupled/metabolism

• Crohn’s disease
• Inflammatory bowel disease
• Microbiome
• Mucosal microbiome

• Bacteria/classification
• Case-Control Studies
• Colon/pathology
• Feces/microbiology
• Female
• Gastrointestinal Microbiome
• Humans
• Inflammatory Bowel Diseases/microbiology
• Intestinal Mucosa/microbiology
• Intestinal Mucosa/pathology
• Male
• Middle Aged
• RNA, Ribosomal, 16S/genetics

Inflammatory bowel diseases (IBD) are debilitating chronic inflammatory disorders that develop as a result of a defective immune response toward intestinal bacteria. Intestinal dysbiosis is associated with the onset of IBD and has been reported to persist even in patients in deep remission. We investigated the possibility of a dietary-induced switch to the gut microbiota composition using Winnie mice as a model of spontaneous ulcerative colitis and chow enriched with 1% Bronze tomato. We used the near isogenic tomato line strategy to investigate the effects of a diet enriched in polyphenols administered to mild but established chronic intestinal inflammation. The Bronze-enriched chow administered for two weeks was not able to produce any macroscopic effect on the IBD symptoms, although, at molecular level there was a significant induction of anti-inflammatory genes and intracellular staining of T cells revealed a mild decrease in IL17A and IFNγ production. Analysis of the microbial composition revealed that two weeks of Bronze enriched diet was sufficient to perturb the microbial composition of Winnie and control mice, suggesting that polyphenol-enriched diets may create unfavorable conditions for distinct bacterial species. In conclusion, dietary regimes enriched in polyphenols may efficiently support IBD remission affecting the intestinal dysbiosis.

• bronze tomatoes
• inflammatory bowel disease (IBD)
• microbiota
• murine models
• polyphenols

• Evolution
• Gene families
• Inflammation
• Multi–omic approach

• Comorbidity
• DNA Methylation/genetics
• Gene Expression Profiling
• Gene Expression Regulation
• Gene Regulatory Networks
• Genetic Association Studies
• Genomics/methods
• Humans
• Inflammation/genetics
• Inflammation/pathology
• Multigene Family
• Phylogeny
• Principal Component Analysis
• Receptors, Tumor Necrosis Factor/genetics
• Signal Transduction

• Clostridium butyricum
• Lactobacillus acidophilus
• cytokine
• inflammation
• ulcerative colitis

• Dietary fiber
• FMT
• Prebiotics
• Probiotics
• Symbiotics

Imbalances in intestinal bacteria correlate with colitis-associated colorectal cancer (CAC). Traditional Chinese medicines have been used to adjust the gut microbiota, and isoliquiritigenin (ISL), a flavonoid extracted from licorice, has shown antitumor efficacy. In this study, the effects of ISL on CAC development and the gut microbiota were evaluated using an azoxymethane and dextran sulphate sodium (AOM/DSS)-induced mouse model of CAC (CACM). Histopathological analysis suggested that ISL reduced tumor incidence in vivo. Moreover, high-throughput sequencing and terminal restriction fragment length polymorphism (T-RFLP) studies of the bacterial 16S rRNA gene revealed that the structure of the gut microbial community shifted significantly following AOM/DSS treatment, and that effect was alleviated by treatment with high-dose ISL (150 mg/kg). Compared to the microbiota in the control mice (CK), the levels of Bacteroidetes decreased and the levels of Firmicutes increased during CAC development. ISL reversed the imbalance at the phylum level and altered the familial constituents of the gut microbiota. Specifically, the abundance of Helicobacteraceae increased after treatment with high-dose ISL, while the abundance of Lachnospiraceae and Rikenellaceae decreased. At the genus level, ISL reduced the abundance of opportunistic pathogens (Escherichia and Enterococcus), and increased the levels of probiotics, particularly butyrate-producing bacteria (Butyricicoccus, Clostridium, and Ruminococcus). Thus, ISL protects mice from AOM/DSS-induced CAC, and ISL and the gut microbiota may have synergistic anti-cancer effects.

• AOM/DSS
• colitis-associated colorectal cancer
• gut
• isoliquiritigenin
• microbiota

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) with chronic and recurrent characteristics caused by multiple reasons. Although the pathogenic factors have not been clarified yet, recent studies have demonstrated that intestinal microbiota plays a major role in UC, especially in the immune system. This review focuses on the description of several major microbiota communities that affect UC and their interactions with the host. In this review, eight kinds of microbiota that are highly related to IBD, including Faecalibacterium prausnitzii, Clostridium clusters IV and XIVa, Bacteroides, Roseburia species, Eubacterium rectale, Escherichia coli, Fusobacterium, and Candida albicans are demonstrated on the changes in amount and roles in the onset and progression of IBD. In addition, potential therapeutic targets for UC involved in the regulation of microbiota, including NLRPs, vitamin D receptor as well as secreted proteins, are discussed in this review.

• epithelial cells
• host immune response
• intestinal microbiota
• therapeutic targets
• ulcerative colitis

• Euphorbia supina (ES)
• dextran sulfate sodium, colitis
• iNOS, COX-2
• myeloperoxidase

Recent developments in analytical techniques including next-generation sequencing have clarified the correlation between intestinal microbiota and inflammatory bowel disease. Fecal microbiota transplantation (FMT) for patients with ulcerative colitis (UC) is proposed as a potential approach to resolving their dysbiosis; however, its safety and efficacy have not been confirmed. This single-arm, open-label, non-randomized study aimed to evaluate the safety and efficacy of FMT for Japanese patients with UC as the first registered clinical trial in Japan.

We enrolled 10 patients with active UC despite medical therapy. The donors were the patients' relatives and were carefully screened for infectious diseases. Fecal material was administered via colonoscopy, and the primary endpoint was the presence or absence of serious adverse events related to FMT. The secondary endpoint was a change in partial Mayo score at 12 weeks post-FMT. Scores ≤2 were considered a clinical response. Fecal samples were collected to follow changes in gut microbiota, while extracted complementary DNA were analyzed by a next-generation sequencer. We obtained written informed consent from all patients and donors. This study was approved by our Institutional Review Board and is registered in the University hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN 000012814).

Five patients with moderate disease and five with severe disease were enrolled. No severe adverse effects were observed. One patient achieved clinical response; however, none of the patients' microbiota diversity recovered to the donor levels.

The use of single FMT for UC was safe; however, we failed to show its clinical efficacy and potential to change the intestinal microbiota.

• Colitis, ulcerative
• Dysbiosis
• Fecal microbiota transplantation

AIM: To evaluate the effect of oral Escherichia coli (E. coli) Nissle application on the outcome of intestinal-borne dermatoses.

METHODS: In a randomized, controlled, non-blinded prospective clinical trial 82 patients with intestinal-borne facial dermatoses characterized by an erythematous papular-pustular rash were screened. At the initiation visit 37 patients entered the experimental arm and 20 patients constituted the control arm. All 57 patients were treated with a vegetarian diet and conventional topical therapy of the dermatoses with ointments containing tetracycline, steroids and retinoids. In the experimental arm patients received a one month therapy with oral E. coli Nissle at a maintenance dose of 2 capsules daily. The experimental group was compared to a non-treatment group only receiving the diet and topical therapy. The primary outcome parameter was improvement of the dermatoses, secondary parameters included life quality and adverse events. In addition the immunological reaction profile (IgA, interleucin-8 and interferon-α) was determined. Furthermore the changes of stool consistency and the microbiota composition over the time of intervention were recorded.

RESULTS: Eighty-nine percent of the patients with acne, papular-pustular rosacea and seborrhoic dermatitis responded to E. coli Nissle therapy with significant amelioration or complete recovery in contrast to 56% in the control arm (P < 0.01). Accordingly, in the E. coli Nissle treated patients life quality improved significantly (P < 0.01), and adverse events were not recorded. The clinical improvement was associated with a significant increase of IgA levels to normal values in serum as well as suppression of the proinflammatory cytokine IL-8 (P < 0.01 for both parameters). In the E. coli Nissle treated group a shift towards a protective microbiota with predominance of bifidobacteria and lactobacteria (> 10⁷ CFU/g stool) was observed in 79% and 63% of the patients, respectively (P < 0.01), compared to no change in the control group without E. coli Nissle. Moreover, the detection rate of a pathogenic flora dropped from 73% to 14 % of the patients in the experimental arm (P < 0.01) with no significant change in the control arm (accounting 80% before and 70% after the observation period, P > 0.05). Accordingly, stool consistency, color and smell normalized in the E. coli Nissle treated patients.

CONCLUSION: E. coli Nissle protects the mucus barrier by overgrowth of a favorable gut microbiota with less immunoreactive potential which finally leads to clinical improvement of intestinal borne dermatoses.

• Intestinal-borne dermatoses
• Escherichia coli Nissle 1917
• Immunological response
• IgA
• Interleukin-8
• Interferon-α
• Gut microbiota

• Administration, Cutaneous
• Administration, Oral
• Adult
• Biological Therapy/adverse effects
• Biological Therapy/methods
• Capsules
• Diet, Vegetarian
• Escherichia coli/immunology
• Female
• Gastrointestinal Microbiome
• Humans
• Immunoglobulin A/blood
• Interferon-alpha/blood
• Interleukin-8/blood
• Intestinal Diseases/complications
• Intestinal Diseases/microbiology
• Intestines/microbiology
• Male
• Probiotics/therapeutic use
• Prospective Studies
• Quality of Life
• Signal Transduction
• Skin Diseases/diet therapy
• Skin Diseases/etiology
• Skin Diseases/immunology
• Skin Diseases/therapy
• Treatment Outcome

Background. Recently, the importance of the gut microbiota in the pathogenesis of several disorders has gained clinical interests. Among exogenous factors affecting gut microbiome, diet appears to have the largest effect. Fatty acids, especially omega-3 polyunsaturated, ameliorate a range of several diseases, including cardiometabolic and inflammatory and cancer. Fatty acids associated beneficial effects may be mediated, to an important extent, through changes in gut microbiota composition. We sought to understand the changes of the gut microbiota in response to an omega-3 rich diet. Case Presentation. This case study investigated changes of gut microbiota with an omega-3 rich diet. Fecal samples were collected from a 45-year-old male who consumed 600 mg of omega-3 daily for 14 days. After the intervention, species diversity was decreased, but several butyrate-producing bacteria increased. There was an important decrease in Faecalibacterium prausnitzii and Akkermansia spp. Gut microbiota changes were reverted after the 14-day washout. Conclusion. Some of the health-related benefits of omega-3 may be due, in part, to increases in butyrate-producing bacteria. These findings may shed light on the mechanisms explaining the effects of omega-3 in several chronic diseases and may also serve as an existing foundation for tailoring personalized medical treatments.

• Crohn's disease
• Inflammatory bowel disease
• Nutrition
• Ulcerative colitis

The intestinal microbiome is a dynamic system of interactions between the host and its microbes. Under physiological conditions, a fine balance and mutually beneficial relationship is present. Disruption of this balance is a hallmark of inflammatory bowel disease (IBD). Whether an altered microbiome is the consequence or the cause of IBD is currently not fully understood. The pathogenesis of IBD is believed to be a complex interaction between genetic predisposition, the immune system and environmental factors. In the recent years, metagenomic studies of the human microbiome have provided useful data that are helping to assemble the IBD puzzle. In this review, we summarize and discuss current knowledge on the composition of the intestinal microbiota in IBD, host-microbe interactions and therapeutic possibilities using bacteria in IBD. Moreover, an outlook on the possible contribution of bacteriophages in the pathogenesis and therapy of IBD is provided.

• Microbiota
• Inflammatory bowel disease
• Gut
• Bacteriophages
• Bacterial therapy

• Anti-Bacterial Agents/therapeutic use
• Bacteria/drug effects
• Bacteria/virology
• Bacteriophages
• Dysbiosis
• Fecal Microbiota Transplantation
• Gastrointestinal Microbiome/drug effects
• Host-Pathogen Interactions
• Humans
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/immunology
• Inflammatory Bowel Diseases/microbiology
• Inflammatory Bowel Diseases/therapy
• Intestines/drug effects
• Intestines/immunology
• Intestines/microbiology
• Probiotics/therapeutic use

Medical therapy of mild and moderate ulcerative colitis (UC) of any extent is evidence-based and standardized by national and international guidelines. However, patients with steroid-refractory UC still represent a challenge.

A literature search using PubMed (search terms: ulcerative colitis, therapy, new, 1-2008-2015) resulted in 821 publications. For the current article, 88 citations were extracted including 36 randomized controlled studies, 18 reviews, and 8 meta-analyses.

In steroid-refractory UC, early intensive therapy using anti-tumor necrosis factor (TNF) antibodies or the calcineurin inhibitors cyclosporine and tacrolimus is indicated in any case to prevent progression to a toxic megacolon and/or to avoid proctocolectomy. In patients with chronic disease activity, treatment with anti-TNF antibodies has a higher level of evidence than azathioprine therapy and should therefore be preferred. However, there is a subgroup of UC patients who may achieve prolonged steroid-free remission on azathioprine monotherapy. The importance of vedolizumab, a newly registered inhibiting antibody against integrin, has not yet been fully clarified since direct comparison studies are lacking, in particular in relation to anti-TNF antibodies.

There is a great need for additional innovative therapies, especially in cases of primary non-response or secondary loss of response to anti-TNF antibodies. New small molecules (Janus kinase inhibitors) are promising with an acceptable safety profile and efficacy in UC. Further, strategies that target the intestinal microbiome are currently considered for patients with active or relapsing UC, and may in the future open up new therapeutic options.

• Anti-TNF
• Fecal microbiota transfer
• Innovations
• Medical therapy
• Ulcerative colitis
• Vedolizumab

Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, and rebiosis appears likely to be a core component of a path toward sustainable healthcare. Recent findings indicate that: (1) humans are mostly microbial (in terms of numbers of cells and genes); (2) immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs; (3) microbiome status affects early immune education and risk of NCDs, and (4) microbiome status affects the risk of certain infections. Management of the microbiome to reduce later-life health risk and/or to treat emerging NCDs, to spare antibiotic use and to reduce the risk of recurrent infections may provide a more effective healthcare strategy across the life course particularly when a personalized medicine approach is considered. This review will examine the potential for microbiome management to contribute to sustainable healthcare.

• antibiotic resistance
• archaea
• bacteria
• economic burden
• gut microbiota
• immune maturation
• microbiome reconstitution
• non-communicable diseases
• personalized medicine
• pregnancy